Audit shows Lee County Medstar in complete dysfunction

Squabbles, power grabs describe in report.

Oct. 29, 2012

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Clerk of Court auditors warned Monday the mismanagement that led to Medstar’s shutdown created problems that now threaten to bring down all of Lee County’s emergency medical services.

In a draft report Monday, auditors faulted public safety management for the poorly executed policies, lack of oversight, infighting and secrecy that led to the downfall of the county’s medical flight program, Medstar.

“All of Lee County EMS is at risk of imploding, as the Medstar Program did, if the Public Safety Department culture that has prevailed over the past several years is not changed with the upcoming management changes,” according to the report.

Lee County is looking for a new public safety director, EMS chief and county manager, after the three posts were abruptly abandoned in Medstar’s fallout. County Manager Karen Hawes will finish out today and resign to a pay out of more than $250,000, according to the terms of her separation agreement and payroll records.

The Lee County commission called on Clerk of Court Charlie Green to audit Medstar, after The News-Press exposed that officials failed to meet federal safety mandates and erroneously billed patients for about $3.3 million in the run up to its Aug. 21 shutdown.

County officials have one week to respond to the draft report, Green said. Once that happens, Green’s office will issue a final report on the management portion of the program.

Green’s auditors are also working to figure out the erroneous bills county officials sent to patients and insurers, he said. The report on that aspect of the program is due out in the coming weeks, he said.

The management lapses that unraveled Medstar date back to 2004, when officials expanded the program from just carrying county residents to flying patients from all over Southwest Florida, according to the audit.

Under then Public Safety Director John Willson’s “hands off” approach, former Medstar manager Rick O’Neal distanced the program from the rest of the public safety department and its management hierarchy, according to the audit.

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“There was infighting among the top managers within Public Safety, and the Director or Deputy Directors would not intervene to entice the participants to work toward a common mission,” according to the report.

A so-called “silo-mentality” emerged and blocked information-sharing at all levels within the organization, including county management and the commission, according to the audit.

The power struggle boiled over after a helicopter crashed into the waters off North Captiva in 2009, according to the audit and former Medstar pilot Arnold McAllister.

With the helicopter’s crash, ex-EMS chief Kim Dickerson won what McAllister called a “personal beef” with O’Neal, who stepped down as the program’s director.

Dickerson oversaw the grounding of helicopters for a “safety stand-down” in 2011, McAllister said.

“They basically read us the riot act,” McAllister said. “That ‘we work for them; things are going to be different out there.’”

“The perception I think she had is because Rick O’Neal didn’t like her, we were like a nest of traitors out there,” he said.

Another problem the program faced was replacing the helicopter that crashed. According to the audit, it was decided the county manager’s office wouldn’t allow the program to purchase a new helicopter with the insurance money.

Instead, officials bought a 10-year-old helicopter for $2 million and spent an untold amount of money to upgrade it, according to county documents.

Commissioners and county management touted the purchase as a smart move that saved taxpayers money in tough times, according to published reports and press releases.

But today, three of the four companies vying to takeover Medstar for the county won’t fly the aging air ambulance. One of those companies, Med-Trans, noted it would be “cost prohibitive” to fly either of the county’s helicopters, according to its offer to privatize Medstar.

A fourth company, Keystone Med-Flight, states it will charge $1,200 an hour to operate the helicopter – 60 percent more than the price quoted to fly the county’s 24-year-old helicopter.

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While mismanagement and its offshoots caused Medstar’s collapse, "Ultimately the program became dysfunctional because of federal (FAA) certification issues and was shut down,” according to the audit.

County officials flew the 10-year-old helicopter for close to a year without meeting federal safety mandates. They also billed for about $3.3 million in flights — an action that violated rules and prompted a probe by the Federal Aviation Administration that continues.

According to the audit, before commissioners decide whether they want to reinstate Medstar or contract a private company to step in, they should answer these questions:

• Can Lee County Government rebuild a core competency with managers that will achieve and maintain the necessary certifications to run an aviation program or is the best practice to outsource the aviation portion of the program?

• Will the primary service area be Lee County or will Medstar be expanded to a regional program?

• Will the taxpaying citizens of Lee County be required to subsidize the program or will patients and insurers pay for it through fees?

• Should Medstar continue operating under the Public Safety Department or would the service be more better run as a hospital-based service?